Nine Years of a Perfect Implant, Then the Gum Started Bleeding

Quick answer: Implants can develop their own form of gum disease. Bleeding around an implant, or pus, or a gum that has receded, means bone is being lost — and unlike a natural tooth, an implant gives almost no warning until it is well advanced.

The call

Shalom, 58, from RBS Gimmel, had an implant placed nine years earlier that had never given him a moment's trouble. He came in because the gum around it bled when he brushed and had a bad smell, and because the crown looked slightly longer than it used to.

No pain. Implants have no nerve, no ligament and no pain fibres in the way a natural tooth does, which is why patients almost never present early.

What we found

Probing depths of 7mm around the implant on three surfaces, against 3mm at his natural teeth. Bleeding on probing everywhere around it, and a bead of pus on the cheek side. Visible recession, exposing the metal collar — which explained why the crown looked longer.

The x-ray showed a saucer-shaped crater of bone loss around the implant, extending about 4mm down from the shoulder. The implant itself was still firm.

Two conditions exist here, and the distinction determines everything:

Peri-implant mucositis. Inflammation of the gum around the implant, with bleeding but no bone loss. Reversible with proper cleaning. The equivalent of gingivitis.

Peri-implantitis. Inflammation with bone loss around the implant. Not reversible — you cannot regrow the bond between bone and implant surface reliably. The goal is to stop the progression. The equivalent of periodontitis.

His was peri-implantitis, well established.

Why implants are more vulnerable than teeth. A natural tooth is attached to bone by a periodontal ligament with a rich blood supply and fibres that run in protective directions. An implant fuses directly to bone with no ligament, and the gum fibres around it run parallel to the surface rather than inserting into it. That means less blood supply, weaker resistance to bacterial invasion, and faster progression once it starts.

The risk factors: a history of gum disease around natural teeth, smoking, poorly controlled diabetes, cement left under the crown at fitting, an implant placed in a position that cannot be cleaned, and — the most common of all — no maintenance programme.

Shalom had had gum disease before his implant, had never been placed on a maintenance schedule, and had assumed, reasonably, that an implant does not get decay so does not need much attention.

What we did

Non-surgical first: thorough decontamination of the implant surface with titanium-safe instruments and an air-polishing device with glycine powder — the exposed threads cannot be cleaned with ordinary scalers, which scratch the surface and make it worse. Chlorhexidine. Detailed cleaning instruction with interdental brushes sized to the site.

Reassessment at eight weeks: improved, but two sites still bled with 6mm pockets.

Surgical: a flap raised to expose the implant surface directly, granulation tissue removed, the threads decontaminated under vision, the bone architecture smoothed, and the gum sutured to a lower level so he could clean it. Not a regeneration attempt — the defect shape did not favour one.

Maintenance: every three months, indefinitely.

The outcome

Stable at three years, with no further bone loss and no bleeding. He can see and clean the exposed threads, which is not beautiful but is functional and safe.

Left another two years, that implant would very likely have been lost.

What to do if this happens to you

1. Bleeding around an implant is never normal. Report it.
2. Watch for recession, a bad taste, or the crown looking longer.
3. Do not wait for pain. Implants rarely produce it until very late.
4. Insist on probing and x-rays at least yearly. A visual check is not enough.
5. Commit to three- or four-monthly maintenance if you have implants, especially with a history of gum disease.
6. Stop smoking. It is one of the strongest risk factors for implant failure.

Have implants? Ramat Beit Shemesh Urgent Dental Care runs implant maintenance with probing and x-rays. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.